Healthcare Provider Details

I. General information

NPI: 1225628191
Provider Name (Legal Business Name): JAMES WARNER BALLARD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2021
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 S 6TH AVE
TUCSON AZ
85713-4701
US

IV. Provider business mailing address

PO BOX 746093
ATLANTA GA
30374-6093
US

V. Phone/Fax

Practice location:
  • Phone: 520-475-5418
  • Fax: 520-300-8034
Mailing address:
  • Phone: 520-475-5418
  • Fax: 520-300-8034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085.008145
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-11253
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11957
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: